Understanding Basic Insurer Requirements
Lawyers Representing Clients in Texas, Louisiana & Mississippi
Insurance matters can be complicated, calling for qualified and insightful counsel in these areas. If you are wondering what the basic insurer requirements in your state are and how those may affect your claim, Arnold & Itkin is here to provide answers. We understand that this can be an overwhelming and challenging time—especially when working with difficult insurance companies to get claims resolved. We are here to help.
Insurer Requirements in Texas
Pursuing an insurance claim in Texas? There are few things you should know in regards to insurer requirements.
For example, within 15 business days of your notice, an insurer must:
- Acknowledge their receipt of your claim;
- Begin any necessary investigation of the claim; and
- Request any items, statements, or forms needed.
Once the insurer has received all items they believe necessary, they are typically required to notify you whether they have accepted or rejected your claim within another 15 business days. Following this, an insurer must provide payment for the claim (if accepted) within 60 days of receiving the materials they requested. It is also important to know that insurers are obligated by a duty to deal fairly and in good faith when processing and paying claims. That means unnecessary delays or denials may leave room for further legal action. If insurers deny or delay a claim, they must be able to establish a bona fide reason as to why this action is appropriate to avoid liability.
Insurer Requirements in Louisiana
In Louisiana, insurers are not held under as strict policies as they are in Texas. Under the law, an insurer must merely acknowledge a claim in a prompt timeframe and investigate this claim within a reasonable period, leaving much room for interpretation as to what “prompt” and “reasonable” mean. Claims filed under health and accident policies, however, must be paid within 30 days from when the insurer first receives notice of and evidence for the claim. Louisiana does have similar requirements on good faith and fair dealing under La. R.S. 22:1882 and 22:1973.
All insurance companies in Louisiana are expected to:
- Treat their policyholders fairly and in good faith
- Provide full payment of the validated claim within 30 days
- Take steps to adjust the claim within 14 days of receipt
- Pay settlement agreement in a reasonable, timely fashion
- Avoid misrepresenting important facts or policy
- Adjust insurance claims fairly
If insurance companies fail to act within these requirements, they may be liable for damages suffered by their policyholders.
Insurer Requirements in Mississippi
Similar to other states, Mississippi requires insurers to conduct a “reasonably prompt” investigation of all the relevant facts and information they have been given regarding a claim. The insurer must perform a full and adequate investigation of the claim promptly. Additionally, if an insurer wishes to deny a claim, they must be able to present an arguable basis for their denial of the claim and must do so in good faith.